RESUMO
The management of perioral injuries is a complex topic that must take into consideration the unique anatomy, histology, and function of the lips to best restore form and function of the mouth after injury. Basic reconstructive principles include three-layered closure for full-thickness lip lacerations. Additionally, special care is needed to ensure an aesthetic repair of the cosmetically complex and important vermillion border, philtrum, and Cupid's bow. Infraorbital and mental nerve blocks provide lip anesthesia for laceration repair without distorting crucial aesthetic landmarks. Prophylactic antibiotics are usually indicated in perioral injuries due to wound contamination with saliva. Perioral burn management is controversial; however, most lip burns can first be managed conservatively. Splinting, plasties, and other reconstructive options are available after secondary healing of perioral burns. Hypertrophic scars are common in the perioral area after trauma. The mainstays of treatment for hypertrophic scars on the lips are silicone elastomer sheeting and intralesional steroid injections. For large perioral defects, a myriad of reconstructive options are available, ranging from primary closure, cross-lip flaps, and local tissue transfer, to free tissue transfers such as radial forearm free flaps, innervated gracilis free flaps, anterolateral thigh free flaps, and osteocutaneous free flaps.
Assuntos
Traumatismos Faciais/terapia , Lábio/lesões , Boca/lesões , Procedimentos de Cirurgia Plástica/métodos , Cirurgia Plástica/métodos , Humanos , Lábio/anatomia & histologia , Lábio/cirurgia , Boca/cirurgia , Procedimentos Cirúrgicos Bucais/métodosRESUMO
Objectives We analyze the relationship between CD44, epidermal growth factor receptor (EGFR), and p16 expression in oral cavity and oropharyngeal cancers in a diverse population. We also describe whether particular patterns of staining are associated with progression-free survival and overall survival. Study Design Prospective study, single-blind to pathologist and laboratory technologist. Setting Hospital based. Subjects and Methods Immunohistochemistry, comprising gross staining and cellular expression, was performed and interpreted in a blinded fashion on 24 lip/oral cavity and 40 oropharyngeal cancer specimens collected between 2007 and 2012 from participants of a larger study. Information on overall survival and progression-free survival was obtained from medical records. Results Nineteen cases were clinically p16 positive, 16 of which were oropharyngeal. Oral cavity lesions were more likely to exhibit strong CD44 membrane staining ( P = .0002). Strong CD44 membrane and strong EGFR membrane and/or cytoplasmic staining were more common in p16-negative cancers ( P = .006). Peripheral/mixed gross p16 staining pattern was associated with worse survival than the universal staining on univariate and multivariate analyses ( P = .006, P = .030). This held true when combining gross and cellular localization for p16. For CD44, universal gross staining demonstrated poorer overall survival compared with the peripheral/mixed group ( P = .039). CD44 peripheral/mixed group alone and when combined with universal p16 demonstrated the best survival on multivariate analysis ( P = .010). Conclusion In a diverse population, systematic analysis applying p16, CD44, and EGFR gross staining and cellular localization on immunohistochemistry demonstrates distinct patterns that may have prognostic potential exceeding current methods. Larger studies are warranted to investigate these findings further.
Assuntos
Complexo 2-3 de Proteínas Relacionadas à Actina/análise , Biomarcadores Tumorais/análise , Carcinoma de Células Escamosas/química , Receptores ErbB/análise , Receptores de Hialuronatos/análise , Boca/química , Neoplasias Orofaríngeas/química , Idoso , Carcinoma de Células Escamosas/mortalidade , Carcinoma de Células Escamosas/patologia , Intervalo Livre de Doença , Feminino , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Boca/patologia , Proteínas de Neoplasias/análise , Neoplasias Orofaríngeas/mortalidade , Neoplasias Orofaríngeas/patologia , Prognóstico , Estudos Prospectivos , Método Simples-Cego , Taxa de SobrevidaRESUMO
Modern cosmetic medicine requires accurate recognition of all types of rhytids and their molecular causes such that treatments may be tailored for improving skin appearance for each unique patient. This article examines the causes and treatment of fine rhytids. Laser rejuvenation therapies that affect the epidermis, dermis or both and induce neocollagenesis and dermal remodeling can be effective against the stigmata of mature skin.
Assuntos
Técnicas Cosméticas , Lasers de Gás/uso terapêutico , Lasers de Estado Sólido/uso terapêutico , Envelhecimento da Pele/efeitos da radiação , Face/patologia , Face/efeitos da radiação , Humanos , Envelhecimento da Pele/patologiaRESUMO
This article reviews a series of in vitro and in vivo studies that examined the otoprotective efficacy of locally delivered dexamethasone and explored the mechanisms by which dexamethasone protects auditory hair cells. These studies used auditory threshold testing in response to pure tone stimuli, organ of Corti explant cultures, FITC-phalloidin-stained explants, and surface preparations to determine hair cell density, osmotic pump delivery of dexamethasone into the scala tympani, an animal model of electrode insertion trauma (EIT)-induced hearing loss, and real-time RT-PCR studies of gene expression levels. Local delivery of two different formulations of dexamethasone conserved hearing and protected hair cells in an animal model of cochlear implantation. Dexamethasone treatment protected hair cells in organ of Corti explants exposed to an ototoxic level of an inflammatory cytokine, and gene expression studies showed that this protection was accomplished by increased expression levels of anti-apoptosis genes (e.g. Bcl-2) and decreased levels of pro-apoptosis genes (e.g. Bax). We conclude that dexamethasone is an effective otoprotective drug for both the conservation of hearing and preservation of hair cells against trauma-induced losses. Locally delivered dexamethasone is a promising therapeutic approach for the conservation of hearing during the process of cochlear implantation.
Assuntos
Anti-Inflamatórios/administração & dosagem , Limiar Auditivo/efeitos dos fármacos , Implante Coclear/efeitos adversos , Surdez/etiologia , Dexametasona/administração & dosagem , Eletrodos Implantados/efeitos adversos , Células Ciliadas Auditivas/efeitos dos fármacos , Mediadores da Inflamação/metabolismo , Órgão Espiral/lesões , Administração Tópica , Animais , Apoptose/efeitos dos fármacos , Audiometria de Tons Puros , Contagem de Células , Citocinas/metabolismo , Modelos Animais de Doenças , Expressão Gênica/efeitos dos fármacos , Expressão Gênica/genética , Cobaias , Humanos , Técnicas In Vitro , Órgão Espiral/efeitos dos fármacos , Proteínas Proto-Oncogênicas c-bcl-2/genética , Ratos , Rampa do Tímpano/efeitos dos fármacos , Fator de Necrose Tumoral alfa/metabolismo , Proteína X Associada a bcl-2/genéticaRESUMO
HYPOTHESIS: Dexamethasone (DXM) protects hearing against trauma-induced loss. MATERIALS: in vivo: A guinea pig model of electrode induced trauma (EIT)-induced hearing loss was used to locally deliver dexamethasone. In vitro: TNF-α-challenged organ of Corti explants treated with DXM or polymer-eluted DXM +/- PI3K/Akt/PkB/NFkB inhibitors were used for hair cells count and gene expression studies. RESULTS: in vivo: local DXM treatment of EIT-animals prevents trauma-induced loss of ABR thresholds that occurs in EIT-animals and EIT-animals treated with the carrier solution (i.e., AP), and prevented loss of auditory hair cells. In vitro: DXM and polymer-eluted DXM were equally effective in protecting hair cells from ototoxic levels of TNF-α Inhibitor treated explants demonstrated that DXM treatment requires both Akt/PKB and NFkB signalling for otoprotection. DXM treatment of explants showed up regulation of anti-apoptosis related genes (i.e., Bcl-2, Bcl-xl) and down regulation of pro-apoptosis related genes (i.e., Bax, TNFR-1). CONCLUSIONS: DXM exert its otoprotective action by activation of cell signal molecules (e.g., NFkB) that alter the expression of anti- and pro-apoptosis genes.
Assuntos
Dexametasona/farmacologia , Proteínas Ativadoras de GTPase/metabolismo , Células Ciliadas Auditivas/efeitos dos fármacos , Perda Auditiva/prevenção & controle , Fator de Necrose Tumoral alfa/efeitos adversos , Animais , Apoptose/efeitos dos fármacos , Apoptose/genética , Limiar Auditivo/efeitos dos fármacos , Células Cultivadas , Modelos Animais de Doenças , Regulação para Baixo , Eletrodos Implantados/efeitos adversos , Proteínas Ativadoras de GTPase/genética , Regulação da Expressão Gênica , Cobaias , Células Ciliadas Auditivas/citologia , Perda Auditiva/etiologia , Técnicas In Vitro , Órgão Espiral/efeitos dos fármacos , Distribuição Aleatória , Reação em Cadeia da Polimerase em Tempo Real , Valores de Referência , Fator de Necrose Tumoral alfa/farmacologia , Regulação para Cima , Ferimentos e Lesões/complicaçõesRESUMO
A single injection of ML29 reassortant vaccine for Lassa fever induces low, transient viremia, and low or moderate levels of ML29 replication in tissues of common marmosets depending on the dose of the vaccination. The vaccination elicits specific immune responses and completely protects marmosets against fatal disease by induction of sterilizing cell-mediated immunity. DNA array analysis of human peripheral blood mononuclear cells from healthy donors exposed to ML29 revealed that gene expression patterns in ML29-exposed PBMC and control, media-exposed PBMC, clustered together confirming safety profile of the ML29 in non-human primates. The ML29 reassortant is a promising vaccine candidate for Lassa fever.